Soft Tissue Therapy: A Discussion with Anna Maria Mazzieri

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We welcome Anna Maria Mazzieri, a soft tissue therapist and educator from the UK. We share our stories and insights that hope to reshape the landscape of manual therapy. Together, we dismantle the problems of outdated therapeutic models so we can build a new framework where evidence-based practice is the core of clinical success. Anna Maria's expertise, cultivated at the Soft Tissue School in the UK, offers a refreshing perspective on the significance of integrating communication, reassurance, and rehabilitation advice into the holistic treatment of clients.

Join us on our journey as manual therapists as we share our experiences from our professional paths and the impact they have had on our approach to care. This dialogue, rich with anecdotes and reflections, is a testament to the power of lifelong learning and the evolution of our clinical expertise. For practitioners, students, or anyone interested by the art and science of hands-on care, this episode aims to  provide you a deeper connection to the nuances of soft tissue therapy.

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Episode Transcript

Eric (00:08):
Hello and welcome to another episode of Purves Versus
.
My name is Eric Purves.
I'm a massage therapist, coursecreator, continuing education
provider, curriculum advisor andadvocate for evidence-based
massage therapy.
In this episode, we welcomeAnna Maria Mazzieri.
She's a soft tissue therapist,a continuing education provider,
and she also runs her ownschool in the United Kingdom

(00:29):
called the Soft Tissue School.
Over the last few years, annaMaria has become a good friend
and professional colleague ofmine.
In this episode, anna Maria andI discuss a variety of topics,
with our main theme focusing onevidence-based practice and what
this means in clinic, and theeducation for massage and manual
therapists.
We address the topic ofdefining expertise in manual

(00:50):
therapy, the importance ofqualitative research and how
important it is for all manualtherapists to stop searching for
singular causes of pain usingoutdated models.
If you enjoyed this episode,please rate it and share it on
your favorite social mediaplatforms.
You can also support my podcastby making a donation, so please
visit buymeacoffeecom.
Slash helloob and PurposeVersus can be found on YouTube,

(01:15):
so please check us out there andsubscribe.
Thanks for being here and Ihope you enjoy this episode.
Well, hello everybody.
Today I get to welcome the mostwonderful Anna Maria, my
favorite Italian Brit thatexists from Devon.
Is that correct?
Is that where you are?

Anna Maria (01:29):
Correct.
Thank you, favorite ItalianBrit.
I like that yeah.

Eric (01:35):
I was like how am I going to introduce that?
I was like, yeah, that'sfantastic.
So thanks for being here, annaMaria.
We've had many greatconversations before and I think
one of the podcasts that I wason of yours about two or three
years ago with I think it was-Was that long ago, was that?
Long.

Anna Maria (01:51):
It's time to do another one.

Eric (01:54):
Yeah, that one for me that I did with you was I've had
more emails, messages on socialmedia, comments from anybody
that listened to that one thanany other any other podcast I've
ever done.
So I don't know if I've evertold you that, but that was that
one changed my life.
I think it really got my nameand kind of things that are

(02:17):
important to me, which I thinkare important, got that out
there to the world.

Anna Maria (02:20):
So thank, you, no, no, wonderful wonderful, yeah,
yeah.
So let's just introduceyourself tell us a little bit
about who's Anna Maria and telland got that out there to the
world.

Eric (02:26):
So thank you, no, no, wonderful, wonderful, yeah, yeah
.
So let's just introduceyourself.
Tell us a little bit aboutwho's Anna Maria and tell us
what you're all about.

Anna Maria (02:30):
Oh, it's always very difficult, isn't it?
Talking about oneself.
Well, I always say I identifymyself as a soft tissue
therapist.
A soft tissue therapist is inthe UK, is a title that we have
adopted from.

(02:52):
We have adopted from the origin.
They used to be clinical andsports remedial massage.
We have adopted, we haveadopted this title because we
wanted to come out a little bitfrom clients to identify us only
through our modalities.
So to us, soft tissue therapywas encompassing a tiny more of

(03:16):
a broader skill set, which isabout treating the person with
different, you know, like, like,with communication, with
reassurance, with massage, withrehab advice and so on.
So that's why I identify myselfas a soft tissue therapist.
I have been in practice for 22years, although I came to this

(03:39):
country, to England, to studyarchaeology, so still working
with the bodies, but these onesare alive.
So then I moved on to massagetherapy, just as a.
I remember I did a course justfor interest and literally
falling in love with it.

(03:59):
All of a sudden things likemade sense and I progressed into
more clinical aspects ofmassage therapy and I'm just
falling in love with it.
And I've been in practice eversince I attended a degree in

(04:21):
sports therapy, because I wantto go to do my master's in
neuroscience and psychology.
So hopefully, as long as wedon't have another COVID tragedy
or anything like that,hopefully 2024 is going to be
the the master's year for me,and because I always been very
disappointed.

(04:52):
I found that what I was taughtat college never, never made
sense, or what I was seeing inclinical practice, and so I kept
doing courses and courses totry to find a making sense, and
I never made sense.
In fact, even now it is quitedifficult to make sense.

(05:18):
And so I started Educating aswell, starting teaching, and
Really, again, I found a new,new way, another passion of mine
to actually share in the roomwith.
I love, when people come intothe profession, that they do not
have an experience in theprofession and they come in with

(05:39):
the most amazing, originalquestions that one doesn't even
think about sometimes, you know,and still, even after you know
15 year teachings, I got thestudents you know coming in and
says, oh, but what about this?
And I thought, oh, I neverthought of that.
So I love these challenges fromthe students.

(05:59):
Um, so now let's say that I Ishare time between clinical
practice, which for me is reallyimportant because that's where
I truly learn the experience ofour clients, but also teaching

(06:19):
both courses, qualificationcourses, diploma courses, but
also CPD, which in your countryI think you call this CEU.
And also I've been very, verylucky, I feel very privileged,
that recently I have been partof three studies with an

(06:42):
international group ofoutstanding researchers and
clinicians.
One study has been published.
It's about manual therapy indifferent pain phenotypes, and
the other two they are goingthrough review at the moment.
So I felt really privileged,because I do not have any

(07:07):
experience in research, apartfrom being an avid reader of
research.
But I think it was wonderfulthat, in this case, appreciated
the value of expertise away fromresearch.

(07:32):
And it was great Because whenwe had to put down our what do
you call it?
Credentials and paperpublications, some of them had
100 plus publications.
Mine was a fat zero, but thatwas interesting because again,

(07:54):
then the question comes how dowe define expertise?
That's expertise, for this case, in manual therapy, is
expertise in manual therapy?
One criteria to consideroneself an expert is that of
having published work.

(08:15):
It's years of practice.
How, how does one so?
That that was was interesting.

Eric (08:23):
so I just a little bit of a shout out about the paper yeah
, yeah, I know we should uh sendme the the link to that.
I know I've read the paper uh,because I believe I was one of
the people that uh submitted uhsome data for correct, correct.

Anna Maria (08:38):
so we said yes, and what I really liked?
There were already some, let'ssay, limitations, even the fact
that it's divided into painphenotypes.
I have some reservations withit, but we decided you know, it
was decided to take the IASP,the National Association of

(09:03):
Stylian Pain definitions, andthen work from there.
So that's fine.
But what was really interestingis the type of study.
So we are trying to find morequalitative studies and becoming
better qualitative studies, andthat, I think, has to be uh,

(09:24):
praised, credited for sure yeah,yeah, I I.

Eric (09:28):
I like that the, the, the paper, and I've read it when it
came out, but it was a couplemonths ago now, so I can't
really remember what, what, whatcame out, what the findings
were.
But I do.
My bias is towards qualitativestuff.
You know the um, some of thework that I did in my graduate
studies was qualitative and itjust to me I mean, okay, you

(09:51):
need both.
Right, you need quantitative,you need numerical data, but you
also need the stories and theexperiences to kind of get a
better picture.
Personally, though, I feel likein soft tissue massage, manual
therapy, qualitative to me seemsto make more sense because it's
more about what somebody'sexperience who?
Maybe they have this type ofpain phenotype, but what's?

(10:14):
And then so say you could studylike, well, what's your
experience when you get manualtherapy?
You know what's that mean toyou and how valuable is that to
you, and you can ask kind of Ifeel, more clinically relevant
questions in a qualitative studythan you can.

Anna Maria (10:28):
Yes, but also because according to what you
want, to what question you wantto have answered.
So, obviously, if we want tofind cause, rct is the best.
Of course, yes, rct is the bestOf course yes.

(10:50):
However, and obviously of course, in our profession, RCTs are
still valuable.
However, we know that there isso much.
There is limitations, becauseit's very complex in our
profession to mitigate some ofthe contextual factors and so on
.
So that's why I thinkqualitative has we can look at

(11:12):
different things withqualitative, and this is the
point and please tell me if I'mgoing a little bit off track,
because I think this is quiteimportant Do we need to change
the way we research?
Do we need to change the way weresearch?
Do we need to change thequestions we are asking?
Because, you see, do we reallyneed to know now what the cause,

(11:36):
in this case, the exactmechanisms?
I don't think that.
Yes, a part we need to know,but shouldn't we focus a little
bit more on actually, let's moveaway from the mechanism and see
what is the person's experiencewithin the context that create

(11:59):
a positive outcome, instead oflooking what is the causation of
that particular effect, whyproviding a deep type of stroke
or high-velocity thrust willaffect pain.

(12:20):
No, let's have a look instead.
This is one or the other side.
What are the gaps in research?
And this is the other studythat is going to come out soon,
hopefully as soon as it's beenreviewed, but this is another
one.
Shall we start changing thequestion we're asking?

Eric (12:40):
I would think that's a great idea.
Sorry, I didn't mean tointerrupt there.
No, I think it's a great idea,because so often, right, we see
this and you know, I know youand I spend probably more time
than you want to me anyway, Isee to see that as leading us

(13:07):
kind of down this path.
That can never be, that it'snever going to end, you know,
because we can't fix it right.
So let's, I like what you said,like what's their experience,
and that's what we should be,what our focus is on
predominantly for what we doclinically.

Anna Maria (13:22):
So ask you know, absolutely I.
I was on it on thisconversation very recently, one
of the forum, with lovely lovelyI think he's a mctimony
chiropractor, lovely, lovely man, phil greenfield.
And what he did say we'retalking.
He said but anna, how do you,how you, how can you communicate

(13:43):
?
She said, you know, if we'renot looking for cause, how do we
communicate that?
Then to the client I said youknow, I actually feel what I'm,
I'm trying, you know, in thelast few years I'm trying to do
with my clients, is moving themaway to wanting a cause for the
problem.
What I'm saying, what I'm tryingto explain to them, that that

(14:07):
that experience of pain orinjury is come because different
risk factors which have beenbuilding up at a certain time,
all of a sudden, boom, boom,they got together at the right
time, in the right amount tocreate, to drive that particular

(14:27):
experience.
So it's not a cause, because Ithink that's where our
responsibility we need to getaway to.
We need to help our clients toget away from wanting that
singular cause to to validate,being able to validate because
they want the singular cause.
This is what I make sense inmyself, because having the

(14:52):
singular cause validates thepain or their experience, but we
need to make them realise orhelp them to make sense of the
experience without beingvalidated by one cause,
especially not being needed tobe validated by one

(15:14):
physiological cause.
This is why it's reallyimportant to me that we talk
about risk factors.

Eric (15:22):
This is something we see all the time clinically about
risk factors.
Yes, and this is something wesee all the time clinically and
I saw this for years and yearsand always in clinical practices
people would come in and theywould be like, oh, I hurt
because of an insert, thenarrative here, this, this
causal thing.
And then they would and thenyou say, okay, well, you know,
how have you know, have you hadbeen treated for that and how
does it make you feel?
And you kind of get to try totease some of the stuff out of

(15:42):
there.
Oh yeah, I go to see my chiro,I see my physio, I see my other
massage therapist or whatever.
I get injections, and but theystill had pain, even though
their cause.
And so then I found that itallowed us to have a
conversation.
Well, maybe it's, maybe that'snot the cause, like, maybe it's,
that's just that there's some,there's other things going on
that may be part of it.

(16:02):
So you never want to dismiss itbecause you want to validate
them right.
But and and and people had mostpeople have never had those
type of conversations or neverhave had a clinician.
Try to explore somethingoutside of this singular cause,
because what we see a lot in thechronic pain population.
So you said, talking expertiseearlier, our clinical expertise
and my clinical experiencesuggests that what most people

(16:25):
that are given a singular causefor their pain and they're
treated ongoing, they still inpain.
So it can't be that singularcause unless it's, you know,
some type of inflammatorycondition or disease process yes
, so obviously there is.

Anna Maria (16:39):
There are some some very strong nociceptive drivers
which that that's where.
That's where, coming back tothe AISP differentiation, I
don't mind it.
There are some limitations,because sometimes the main
driver of the pain it'snociception, but the experience

(17:03):
of it that affects the sufferingthat comes out of it, it's
still multifactorial and this iswhere, especially as massage
therapists I do think everybodyin our care, especially as
massage therapists our role isto make them, help them to make
sense of the complexity of it,of the, and supporting them

(17:29):
through that.
Yes, I often also say some ofmy let's say, let's call it
speciality is to help youthrough the biomechanical risk
factors.
I'll help you to build the load, reduce the load, you know,

(17:50):
improving range of motion.
So that is a little bit more myspecialty, still psychologically
um kind of um driven practice,but that's where you know I, I
probably work more is with theexercise, with the massage.
So a little bit more thosebiomechanical factors, but at

(18:13):
the same times I bring themawareness that actually you
probably are feeling the painmore today, because you just
said to me that you could notsleep last night because you had
all this, you know, thinkingabout having to go back to work
after having the child and youknow also the fact that your
child doesn't sleep very well atnight and it's not feeling very

(18:35):
well.
So you know these are part ofthe pictures that creates
irritates your system.
That's how I often so, goingback to the causality, I love
the work that Cause Health didyears ago.
It's about let's try to go awayfrom one single cause in

(19:01):
healthcare.
We are too complex for it.

Eric (19:04):
Yeah, yeah.
And this is where this is wherewe I mean the theme of what we
want to talk about today waskind of evidence-based practice.
I think this kind of fits intothat is that, you know, is the,
the evidence-based kind ofideals, which is where we should
be going as a profession.
What I seem to feel andunderstand from reading the

(19:26):
arguments that others make, isthat there's a lot of people
that say, oh yeah,evidence-based practice is good,
of course, but some people arelike, yeah, but it's too
recipe-based, it's tooprescription based, and I was
like, well, that's not, that'sactually is not what it is, but
there's that misunderstanding.
And so to kind of further onthis conversation here is that

(19:48):
you have your clinical expertise.
There is these causativefactors, there is these risk
factors.
If you are having anevidence-based practice, you are
looking at all of these things,not just a singular thing, and
I think that's something that ismisunderstood amongst many
Massively, massively.

Anna Maria (20:06):
Massively and it really kind of saddened me
because they use thatexplanation of recipe cut.
I love what you just said as ajustification for saying oh, in

(20:27):
a person-centered care, you knowwe don't want recipes.
Therefore, you know how can yousupport evidence-based practice
?
My my argument with that isthat, with all due respect for
those people that says that, Ithink they have a deep
misunderstanding of whatevidence-based practice is.

(20:49):
You partly mentioned it thereabout the three key elements of
the judicious application ofclinically relevant current
evidence good quality evidencewith current evidence.
Good quality evidence withtherapist expertise to cater for
the client needs.

(21:10):
But actually I think we need togo a little bit further.
We need to go further inthinking how can we use what we

(21:31):
know in evidence to cater forthis person?
So often people ask the wrongquestion.
That's why one of the majorthings that I teach when I main,
things that I teach when Iteach the evidence-based modules
, is the pico question.
You know how to to the.
You need to learn the rightquestion to ask to the evidence.
What I find often is thatpeople are seeking support for

(21:53):
what they already do, whileinstead the way I would love us
to be thinking it is.
I have somebody coming to mewith Achilles tendinopathy.
Okay, let's have a look.
What does evidence tells meabout one the Achilles
tendinopathy to the livedexperience of the person?

(22:17):
Three, the communicationregarding the therapeutic
encounter, for in in our case istouch.
Put all of that together.
How can, through my expertisebecause again some people think
putting together what theylearned over the years no, how

(22:38):
do I translate all the beautifulevidence and actually put it
together a little bit with myclinical experience?
How do I translate it so thathe actually fulfills the
client's needs?

(22:59):
And this is why we are just toonarrow when we seek an answer to
a question for evidence.
We still think that it is aboutgoing and reading a paper about
the efficacy of oneintervention.
It's more than that, it is waymore than that.

(23:19):
It's things like, for exampleand this is why you know, when
they say manual therapy or touch, you know is short-lived, yes,
but short-lived.
We know also that there is bodyof evidence that's saying to us
that for responders, that ashort-lived pain relief,

(23:43):
short-lived symptom modification, is a diagnostic of better
outcomes.
So even that, if I know thatsomebody you know, I know the
evidence is telling me that.
If I know that.
I know that maybe with thatperson I know in the past, might
have responded to touch.
I might want to use touch.

(24:04):
So it is complex.
It is up to us educators tomake it less complex to our
therapists.
But it's more complex than thecookie cup.

Eric (24:16):
No yeah.

Anna Maria (24:18):
Ultimately.
Oh sorry, no, no go ahead.

Eric (24:20):
No, so go ahead, I'll intervene after.

Anna Maria (24:22):
Ultimately, this is the best we have at the moment
and although we need to try, soto me the limitations of
evidence-based practice, they'renot strong enough to vouch for
people not using it.
Yes, so we cannot find thoseyou know drawbacks or the

(24:45):
limitations and say, oh, becauseof that I'm not using.
I don't think it's a goodenough excuse.

Eric (24:51):
What I was going to say, too, when you're talking about
the people who get short-termpain relief after manual therapy
too, it's also important, too,for us to understand in using
taking that person-centeredapproach, approach which is part
of evidence-based practice.
Right, there's always, there'salways these, these catchphrases
, right, that we're all,everyone throws together, um,
and I think word salad yeah,word, there's, there's.

(25:13):
yeah, I mean, that's maybe adifferent conversation.
We could talk about all thatstuff, uh, but is that
meaningful to the person?
And that's the thing that needsto to, um, to be understood or
asked as well, as it's like okay, so I'm, I'm going to give you
this, this treatment, this isthese are some some techniques
or an approach that has workedin the past, when I've seen this
, you know, and if they get somerelief, but is that meaningful
to them?

(25:33):
Is that, is that helpful tothem?
Do they care?
You know, and that and that'ssomething that we is is missed.
I think too often is that we'relike, oh, this person didn't
respond to to what I did, sotherefore they can't be helped.
And I've heard that a lot fromclinicians and it's like, well,
maybe it's just what, maybe itwhat you tried didn't help on
that day, but maybe tries adifferent and maybe you should

(25:54):
try and find something else thatworks for that person.

Anna Maria (25:55):
So maybe you know what you said there.
It's really made me think ofsomething that's great, eric,
great um eric.
Or maybe for that day, theprimary outcome wasn't the pain
relief.
Yeah, you know, this is thepoint.
We should always ask what isyour primary outcome?
Because sometimes I might notbe able to reduce the pain with

(26:16):
my touch, but I might be able tohold the space of safety, which
that on that day, is moremeaningful for them than being
pain free.
That, I think, is a really,really powerful thing.

Eric (26:28):
You said there actually yeah, and how many times too,
I'm sure yourself and othersthat are listening this podcast
has somebody come in and you'relike, oh, tell me what's going
on.
They tell you this big storyabout their shoulder, their neck
or their back, and and, andthen you're all of a sudden your
clinical reasoning hat goes onyou, you're trying to figure it
out and ask them questions, andthen you're like I know I've

(26:49):
done this before and you kind ofstop yourself and be like is
this something you want me to to, to something you address?
No, I can I just get like anice massage for you know it,
just to just to chill out for alittle bit.
And and you're like, oh, youjust want something.
You don't even want me toaddress, that concern, because
that's not what they're lookingfor, their objective for that
day.
So that's something, too, Ithink we need to ask, because

(27:10):
that used to happen to me allthe time.

Anna Maria (27:12):
That made me really think, eric, about going back,
about the misunderstanding ofpeople about evidence-based
practice.
I've recorded a podcast quiterecently and for a group that,
let's say, it's not known for umfollowing evidence-based

(27:34):
practice because all they'rethey're very modality based,
okay, very modality based, andso I was trying to uh, we want,
me and my colleague Emi, wewanted to do a podcast with them
because we wanted to make themunderstand that it didn't matter
what level of practice theywere, it didn't matter what
modalities they practiced.

(27:56):
Having been evidence-based orat least been evidence informed,
it would have been veryrefreshing and liberating and
indeed open up so many moreoptions for them and understand
the limitation of the experiencethey provide.

(28:16):
And maybe using a differentlanguage could have provided
much more, let's say, providedmuch more, let's say you know
how can you say much more,create better outcome for the

(28:42):
client, even if they areexperiences that did nothing to
do with healthcare.
Anyway, so the host, he said tome so we're talking about
evidence-based practice, and hesaid, oh, but what about if all
those therapists don't want allthese big words and they just
want to give a massage?
And all of a sudden and Ireally like the host and I
really like the host.

(29:03):
He's the kindest and the mostcaring therapist.
But that really triggered me.
Triggered me because to me, allof a sudden in my head came
well, it's not your choice.

(29:28):
There is a point where, if youwant to work with people, that
they are in pain and they havean injury, so in the moment in
which you open your doors topublic, to to members of the
public who actually come to youbecause they say I have a
shoulder pain and I would likeyou to help me with this
shoulder pain, the decision ofwhat and how to approach, or if

(29:52):
you are evidence-based practiceor not, is taken away from you.
Rightly so, because actually,the moment you're working with
people in pain, you are becominghealth care.
Yes, it might be non-registeredhealthcare practitioner, it
might be complementaryhealthcare, but still healthcare

(30:15):
In the moment, which ishealthcare.
We have an absolute duty ofcare again towards those people.
Or do harm harm?
Now we know it doesn't comewith what we do with our hands,
but it will come with what we dowith our words.

(30:36):
So if I say to somebody you knowyour reflexology, doing a
reflexology session, which mightfeel absolutely beautiful, I've
got nothing.
You know, it's a beautifulexperience, it's brilliant.
But if you're starting saying,oh, you know, you've got
sciatica, let me do areflexology session, because you
know the reflexology sessionwill help with your sciatica,

(30:57):
that's a little bit creating asymbol.
The other thing is and this isto me it's even more important
by having somebody on your couchthat should be on somebody
else's office, where they can betreated more efficiently and
effectively.
Therefore, the experience ofsuffering or pain reduces in the

(31:22):
moment in which we keep them inour couch and we don't give
them the choice to go tosomewhere else.
That, to me, is my practice.
I said last night at the redflag course I run.
I said don't you think thatevery single client that comes

(31:42):
to us, they think, well, I trustthe therapist, I trust that the
therapist know, I trust thatthe therapist keep up to date
and I trust that the therapisthas my absolute best interest at
hand.
And if they think that there issomething out there that it is

(32:07):
tested and tried to be moreeffective or quicker effective,
then surely the therapist willrefer it to me.
I think every single personthat comes through our doors,
they think that.

Eric (32:23):
And they should.

Anna Maria (32:24):
They should, yeah.
So the fact that the therapistsays, oh know, let's try this,
let's try now, what do you knowabout the particular condition?
Is there anything we know thatcan work better?
Is there anything that we knowthat could?
Because it doesn't mean thatyou don't need to be part of
this and you know, eric, tell meif I'm going a little bit off.

(32:47):
You know off-cut here, but itis okay.
In the moment in which we wantto, as I said, in the moment in
which we want to work withpeople in pain, we take on a
responsibility and we have to.
However, it is also okay to sayto somebody look, you come to

(33:12):
me because you have sciatica andyou found reflexology really
helpful before.
Look, I am very, very happy toprovide a reflexology session
because this is the experiencethat you want and it's beautiful
.
It's the time for yourself.
However, for the sciaticaitself, I refer you to my

(33:37):
colleague, the physiotherapistdown the road, or the
chiropractor, or the osteopath,or back to your GP.
They're going to take care ofthat.
However, I'm going to give youan experience which is so
powerful for their stress, theyeven their you know an
experience of reflexology.

(33:58):
Somebody likes that is will down, regulate the fears will down,
regulate the the nervous system.
So there is value to that, buta value that is not health care.
This is, for me, it's reallyimportant, it's leisure and it's
good, and I even said in in thepodcast if doing ceremonies

(34:19):
with crystals is what ticks, you, go and do the ceremony with
crystals, but do not use themfor people in order as a
therapeutic intervention.
You know.
Use it as somebody wants toexpand their consciousness,

(34:43):
somebody wants to have anexperience, a different
experience.
This is just.
It's enough to wanting, youknow, a beautiful experience.
This is just is enough towanting, you know that, a
beautiful experience, but it'svery different from our care.
This is where there should be avery no fine line anymore, a
strong line if somebody's going,yeah, I know I love that sorry

(35:04):
yeah, no, sorry.

Eric (35:05):
Uh, I love that, annarie, I think because this is
something that I think you and Ihave had conversations about
this before, but it's aconversation that's not had very
often about the ethical dilemmaof the kind of
pseudo-scientific approachesthat are so common in in our our
world, and so often when wecall that stuff out and you talk

(35:27):
about crystal, you talk aboutreflexology or you talk about
any other type of narrative orunderstanding that is common in
the profession, when youchallenge that, people get very
defensive, because the ethicalthing too, about the like do no
harm and informed consent, issomething that we should talk

(35:48):
more about and it's so importantfor people to understand that.
And you know, this is somethingelse that probably I mean we
could talk forever about thiswould be things like the
informed consent.
So you talked about the fineline between healthcare, right,
so you're selling something or afixed or some therapeutic value
that doesn't have evidence tosupport it, even though maybe

(36:10):
you have clinical experience andsay, oh, I do this thing and
people feel better, right, butyou don't have a plausible,
biological, biologicallyplausible explanation or you
don't have evidence to supportthat.
And if you want to be a healthcare provider, you cannot make
those claims of therapeuticbenefit.
You can say, hey, this issomething that might help, but

(36:32):
we don't know why, we don't knowhow.
Do you want to give it a try andsee if it helps with your
experience?
That's a fine line.
I could get behind that, aslong as you're not selling it as
some optimum therapeuticbenefit.
And this kind of goes with whatyou're saying too about these
modality industries, thosemodality empires, and this kind
of goes with what you're sayingtoo.
But these modality industries,those modality empires, where

(36:52):
they are definitely wanting tosell their approach as being
this is the best approach, thisis the only way, and they're
making a killing selling that.
But ethically, right the people.
If you're selling that andthat's what you're telling your
clients, you're not gettinginformed consent.
They have a duty to understandwhat you're doing, why you're
doing it that's my point withwhat the what the client

(37:13):
believes of us.

Anna Maria (37:15):
I bet they believe that we are totally up to date
with knowledge.
Call it evidence, call itknowledge, but we are not.
That's where I think actuallythere is no informed consent
there then yeah, and that's abig problem.

Eric (37:29):
That's something I'm surprised that doesn't get
talked about enough, and that issomething that I have been on
about for quite a few years, andmost people have just looked at
me with glazed eyes and have noidea what I'm talking about.
So I'm really happy that youhave similar thoughts.

Anna Maria (37:44):
Yeah, because I bet if he goes to court, god forbid,
god forbid.
But if he goes the or at leastthat what you're offering me,

(38:11):
it's equal to something elsethat is effective, because I do
not mind somebody like you justsaid, you know the clinical
expertise, blah, blah, blah,blah.
The first, we try some.
First we work evidence-based.
First, we try some, first wework evidence-based.
Sometimes because of context,we know that very well,

(38:31):
especially with touch, thingsmight not respond very well.
That's why I use massage andtouch and manual therapy,
because manual therapy justprovides me that kind of change
of context and then the sameapproach, the same exercise
might work better because of thechange of context.
In those situations I'm quitehappy to say look in my

(38:53):
experience.
This is so important becausethen the client makes the choice
.
It's, you know, I can say in myexperience, so they can weigh
the knowledge in the right way,knowing that it's only one
person's experience.
If they're happy with that, wecan try that, as long as that

(39:17):
experience doesn't take away theperson's choice to go somewhere
else where they will end thesuffering earlier.
And this is where for me is thebiggest, absolutely the biggest
, as I say, and do you know whatI absolutely loved talking
about.

(39:39):
I absolutely loved going to thepsychedelic conference in Exeter
quite recently in June, and itwas amazing because they give so
much respect to thenaturalistic approach of
psychedelics.
So the psychedelics conferencewas a very academic conference
for psychedelics in mentalhealth but also in pain.

(40:02):
There is research coming up butyou know we need to weigh.
So it was a really good, butwhat they did they showed
tremendous respect for the morenaturalistic approach to
psychedelics.
Now I'm not talking just, youknow, taking magic mushrooms to
go and having a good timetalking about more about plant

(40:23):
medicine and I really enjoyedhow this very high level
academics they looked at thenaturalistic way, like the
shamans and so on, and I saidwhat can we learn from those
ways of using psychedelics?
And I think we can do the same.

(40:44):
So how can we learn from theuse of certain modalities, what
the certain modalities providethat might help in health care?
It's a very different thing tosay.
I use those modalities forhealth care right because the

(41:07):
fact, the line of I want to getbetter and therefore I'm going
to go to somebody that I'mhoping they know best about that
particular problem, it's verydifferent than, oh, I just want
to go somewhere because I want agood experience and that's a
big line to be made.
It's us needed to make theclient aware that that is a big

(41:29):
line to be made.
It's us needed to make theclient aware that that is a line
and that they can come to usfor having a really great
experience if they want, or totherapists to have a great
experience, and that's verybeneficial as part of something,
but not as healthcare.

Eric (41:47):
And this comes down to something I've been on about for
years.
It is a failing of the kind ofentry to practice education, and
I know things aren't regulatedin the UK like the same they are
here.
You know all these problemswe're talking about the lack of
evidence and practice, theseethical dilemmas, kind of fix it
causative approaches, all thesethings we've talked about today

(42:07):
.
These are not things that Iwould say people are making up
on their own.
These are an industry problembecause this is the kind of
narrative that people are taughtin their entry to practice
program and so people arespending a lot of money and time
to learn and they're basicallywill be taught a bunch of
different modalities and someanatomy and physiology and

(42:31):
kinesiology and some pathology.
So there's stuff in there thatyou need to know, but there's
also what do we do with thisinformation?
And it almost always comes downto what modality do I choose to
help to fix this problem or tocorrect this dysfunction?
The problem for me starts like,from day one you're in your,
your massage or soft tissuetraining, and then it just gets

(42:51):
built on from there.
You have an entire industry.
So, like these modality empireindustries that are built on
this framework that is we knownow, is incorrect what modality
do I choose?

Anna Maria (43:05):
this is you just hit the nail in the head.
This is where, when before Isaid about changing our
perspective of evidence-basedpractice this is where we need
to change our mindset we shouldnot think what modality should I
use.
We should think how can Isupport and facilitate that

(43:27):
person to achieve the primary?
Whatever the primary goal is itcould be pain relief, it could
be improved, injury could begoing back with playing rugby,
whatever, with one evidencetells me to my skill set.
So what?

(43:48):
How can I support that?
So we some of and this is wherewe need to be looking at the
clients like we look our ineducation what are the needs?
How does that particular personlearn or understand?
Because I also say and you knowthat you know it's when people

(44:09):
come through our doors, whenthey see people, they are
self-selecting.
So the people that already havetaken the choice to come to you
because they already know thatthey won't touch.
So for us it's a little biteasy.
We know they already areexpecting touch because and

(44:31):
therefore we know that most ofthe time they will respond that
their responders.
So you know we have to to thinkwhat?
What is the person?
How is the person going tobetter make sense of the pain
and how to you know, thenrecover from the pain, from the
injury.
This is this is our skill set.

(44:52):
It's not the modalities.
Our skill set is recognizingthe person, what they need, how
they need it.
Some clients need to actuallyhave less of a massage and more
of a the discussion when theycome in.
Some of my clients they enjoymore the movement aspect of it.
So I have the conversationduring the movement and some of

(45:13):
them I have the conversationthat encounter the interaction
during the massage itself.
It's about the client in frontof us, yeah, and that's
something.

Eric (45:24):
that is, that I find that when in all the like, when I
teach my courses, when I do mylive courses, you know we often
talk about, you know,communication and touch and
movement, exploration and allthese things, and people often
like, well, when, like, how muchdo you talk to the person?
Like, you know, do you do, youdo like a long intake and or
whatever, or, and I'm like, well, it really depends on the
person, right, like, we can do alot of these things while we

(45:47):
are, while they're on the tableor while we have them doing some
movement stuff.
But there is this thing in ourprofession that we feel that
we're not providing value unlessit's all hands on.
Someone pays for a 60 minuteappointment, like some people
are like, well, I give, I haveto give 60 minutes hands on.
And I'm thinking, well, maybeif the person comes in and they

(46:08):
just want a great massage, thenyeah, give them as much as they
paid for.
But maybe the person comes inand they come in because they
want pain relief or they want toimprove their function and
their ability to do somespecific activity.
They want to be able to lookover their shoulder or raise
their arm above their head sothey can grab things from the
top shelf, and maybe that'sgoing to require not just an

(46:30):
hour of hands-on stuff.
So we should ask thosequestions and say, well, what is
it?
What would it be that?
What would a successfultreatment today look like for
you?
You know, and they're like, ohwell, I would like to be able to
, you know, reach above my head.
Okay, does that require 60minutes of hands-on?

(46:53):
Because if the person told youthat's what they want to do and
they leave the appointment beingable to do that thing a little
bit better, then they don't carehow many minutes of hands-on
they had and that, okay, this is.
This is very anecdotal, this ismy experience.
But when people tell you whatthey want and you help them
achieve it, they don't care howthey get there I couldn agree
more.

Anna Maria (47:07):
It's about exposing the client to what their outcome
could look like.
And the other thing is, from aclinical perspective, we need to
stop saying 60-minute treatment.
They're booking 60-minuteappointment.
In that appointment we decidetogether with our client what

(47:29):
that looks like.
This is, again, is where ourskill set is.
If I know that there is aclient that they're expecting
that, I might create a let'scall it an environment where on
the first appointment, I mightdeliver some of the information
while they're having the massageand then slowly, slowly, I'm

(47:53):
taking them out of it Becauseactually, if they come in for
pain and you know particularinjury, I want them to get away
from thinking I just need tocome in for a massage to get my
pain or the range of motion oryou know, going back to function
.
I want people to see I'm veryyou know I'm bang on about it,

(48:14):
but massage or maniotherapy isonly the context.

Eric (48:18):
It's a great context.

Anna Maria (48:19):
I love it, I love providing it, my clients love
receiving it.
But it's only the context inwhich the really true
interaction takes place, whichis therapeutic alliance,
communication which providesreassurance and advice on
lifestyle and helping them tomake sense, and all these other

(48:43):
really meaningful and valuableaspects of the therapeutic
encounter.
Manual therapy is just our,literally it's the environment
where it takes place, thecontext.
Some people do understand, dofeel more prone to understanding

(49:04):
when they get touched.
There are reasons for it, whichis absolutely fine, and this is
why we are in practice, becausesome people do respond to that
Not everybody, but some peopledo.
And that's why, and if we likedoing it, so we like providing
manual therapy, then you knowyou're matching people's needs.

Eric (49:21):
Yeah, yeah, that's such a great point and I love these
conversations, so thanks, thanksfor saying that.
What are your thoughts on thesemodality industries?
Do you think it's ever possiblethat our kind of shared
professions here are ever goingto be able to move past these

(49:41):
kind of modality approaches?

Anna Maria (49:44):
Are they wrong?
This is my point, though.
Are they?
Is the modality that is wrongor is what we use the modality
for?
So, for example, we still teachin our school modalities in

(50:05):
terms of, let's call it, mettechniques or a little bit of
cupping, but we teach them aspart of a varied type of touch,
and I differentiate them.
So massage is something massagegives that long, long sustained

(50:25):
touch, and other techniqueslike, let's say, cupping, it's a
different type of inputsensation.
So that's how I see them, and Idon't dislike that, because
sometimes it's nice to have thevariability of touch for the

(50:48):
person at that time.
What I'm having a little bit ofan issue and I am afraid that in
this country we don't seem toget away from it is that they
see those modalities as theintervention themselves and the
intervention itself, and theyput so much focus on it and they

(51:11):
cherry pick those studies notvery high quality either in
order to give an explanation ofthat, and we don't need that.
You know you can.
You know you can use cupping,as long as it's not the kind of
cupping that gives you all that.
What do you call it?
I don't know what you call,call a dry cap and that gives

(51:32):
you all that oh yeah, bruises.
No, no, we use a very simple,sometimes little silicone cap
just to provide a differentsensation, because the client at
the time might like a differentsensation.
That's why I use kinesio tape.
But my client knows that I usekinesio tape just to give you a

(51:54):
different sensation, not becauseit does anything particular.
You know special.
And this is where I think we'rehaving a little bit of a problem
in our industry.
We're still considering the,the modalities, the driver of
the outcome.
I don't think that it is.
I think we need to switch theonly one part of the

(52:17):
communication process andthey're not what creates the
outcomes.
And until we change thatmindset, until we we really
think, we really understand thatit's more than that
physiological effect, I don'tthink we can.
It's not even about beingevidence-based practitioner here

(52:41):
.
It's about understanding thatthe person's pain and injury and
experience is very complex.
It's way, way beyond the effectthat acupuncture might have.

Eric (52:54):
Yeah, and this is such a I'm you.
You kind of clarified that abit because, yeah, I, I often
will go off about like all thedifferent techniques and and I'm
not against the modalities like.
I'm not against like becausethere's there's different,
different strokes for differentfolks.
Right, there's differentapproaches that you can take.
There's different.
Some people like the the thelike a pokey.

(53:14):
Some people like the, the thekind of like nice flowing sweet
we're going to want the morekind of stretch skin stuff which
people would call myofascial.
You know, like there's somepeople want the light touch or
the met.
Like there's differentapproaches, which I have no
problem, because I think it'sgreat to try different things,
because a different interventionmight uh have a different
impact on on person, right?

(53:35):
So not everyone's, uh, noteveryone's going to respond the
same, and we all know that,clinically, like sometimes you
feel like you've done nothing tosomebody because you've just
kind of like held their head for45 minutes, um, and you know,
but that's like the mostpowerful massage, that's what
they needed.
That's, that's, yeah, yeah, yeahbut the yeah, the issue I get
is when the modalities are soldas doing something magical.

(53:58):
Correct and that's why I talkabout modality empires is that
they're like this is the bestapproach.
But what I am noticing, though,now and I'm sure you notice
this too is that a lot of thesemodality empires are now
starting to throw in terms likebiopsychosocial, evidence-based,
person-centered, you know, painscience, and you start to say

(54:19):
they say, they start to usethese catchphrases which, um, I
mean, we use them too, you and I, I know, because, like it tries
to explain what is we're doing.
But now I'm starting to seethat you put in the last
probably three or four yearsthat everybody else is using
these too, and I think it'sconfusing for the customers.

Anna Maria (54:40):
Very recently I noticed somebody uh, let's say
that until now they sold theirown method.
Okay, you use this method forchronic pain and people will get
better.
So that in itself, you know,using a method for chronic pain

(55:04):
and you get better.
That is the opposite to whatevidence-based practice is,
because one of the things thatwe know from a strong body of
evidence that there is nothingsuperior to anything else for
persistent pain.
So just somebody that anyway.

(55:26):
But recently, because theyrealize a lot, a lot of people
in the, a lot of therapists aremore and more, I think, that
they're starting understandingand seeking to be more

(55:46):
evidence-based or at least beingaware of evidence-based
training.
So they are asking that and Ithink recently they advertised
for something and the kid not,it was a word salad talking
about.
You know, they put within onesentence the biopsychosocial
person center and something else, and I thought you just put it

(56:10):
in literally to attract,probably for SEO purposes,
because you know you're gonna.
You're selling a method.
They are selling an absolutemethod to advertise.
You know, advertising their ownmethod, which is herbs for, you
know, chronic pain, but they'reputting their words by vps and

(56:32):
the words by some sentence.
I think, oh my god, this iswhat people don't understand,
because then, what people do andthis is what I realized on the
podcast I was recently they'retrying to shoehorn modalities
into an evidence base and thisis it's not.
You know, of course you knowyou can shoe show on anything,

(56:55):
but it is the is the absolutemindset.
That is different.

Eric (57:01):
And that's one thing I always like to.
One of the things I focus on somuch when I'm doing my, my live
courses is, you know, bringwhatever technique or modality
you want to the, to the, the,the workshop, or, and you can
use whatever technique ormodality you want to the to the,
the, the workshop, or, and youcan use whatever technique or
modality you want in yourtreatment room.
But what we're going to focus onis we're going to focus on how
do we apply the clinicalreasoning of whatever it is your

(57:24):
favorite technique is, to thepopulation or to the person
that's in front of you.
So if we're doing a low backand pelvic course, for example,
like you know, people often havewhat techniques do I use?
I'm like, well, which ones doyou want to use?
Right, maybe these ones mightwork better for depending on the
presentation, and we try andhave conversations and and uh
discussions on that and demos totrying some different things.

(57:45):
But you know, I see that if wefocus on just like identifying
by modality, we're missing thebigger picture of the person and
we are attributing every singlething in their experience to
some type of dysfunction whichthat modality can then fix.

Anna Maria (58:04):
In air quotes At the same time, though, eric, I am a
strong supporter of of honingin or refining touch, so I do

(58:24):
think that it's actually good toattend some techniques courses
because it helps you refine yourtouch.
Yes, because actually, and andagain, this is total clinical
experience.
There are some type of touchthat are more comfortable than

(58:44):
others, like broad, long, slowstrokes, and somebody that has
been in practice for many yearsand touched and provided touch
with different bodies they wouldhave experienced us, so
learning from those people tocreate an experience.

(59:05):
This is the difference.
We are creating an experiencewith manual therapy or massage.
In our case, we are creating anexperience.
In that experience, there is anoption for behaviour change to
take place, and this is thenit's up to the client.

(59:25):
We are just there to facilitatean experience, what they do
with that.
We can help them and supportthem through that.
It's not the experience thatcreates the change.
The experience provides theoption.
And how can I make thatexperience absolutely
magnificent?
It's providing that beautifultouch.

(59:47):
Sometimes that gets the personlost in their own body, and this
is why I love the link betweentouch and interoception.
There is some evidence comingout of it, or the Laura case,
who is amazing.
She's done some fantastic,really good research on touch,

(01:00:08):
on deep touch.
She's actually trying toeliminate as many contextual
factors as possible and what shehad discovered?
That not only sitatite fibersgets what do we call it
processed into the insularcortex where then they're
processed with emotion.

(01:00:28):
That's why sitatite fibers,light touch, feels pleasant, but
also deep touch.
So what she has found?
That the deep touch stimulatesthe same pleasurable pathways
than light touch.
And would that make anythingdifferent for what we already do

(01:00:49):
?
No, but it's really good toknow.
You know, it's really good toknow why the deep touch.
And then you wonder to know,you know, it's really good to
know why they did the deep touch.
And then you wonder why.
You know again, this is totalpersonal clinical experience the
people that you do those long,long strokes, nice and deep
strokes, they say you know, theyfeel quite, let's say they feel

(01:01:12):
powerful.
It's a powerful experience.
Of course, if they're nice andlong and slow, you have more
time to internalize, there ismore time to connect the
discriminatory touch togetherwith the affective touch.
So there are a lot of thingshappening.

(01:01:34):
So the myofascial people, whenmyofascial, you know, says oh,
wow, you know, I feel so upright.
He said you feel uprightbecause you changed the fascia.
You feel upright becauseactually you had time to process
the sensations.

Eric (01:01:51):
Yes, and that's a less wrong explanation that you just
provided in that and that's, andthat, that's wrong, bravo, let
bravo, less wrong.

Anna Maria (01:01:59):
It's not what exactly is happening, but it's.
This is what research is thereto provide a less wrong
explanation?

Eric (01:02:09):
and when we have that, less wrong explanation.
You know that allows us to bemore ethical and allows us to be
more evidence based in ourapproach.
And I do like what you did say,though, too.
You did say that there was the.
You know, you do encouragepeople to learn different
modalities, and I think so too,because it's a matter of comfort
, right?
If you only know how to doSwedish massage and somebody

(01:02:29):
doesn't respond to that, thenyou don't have another approach.
So I personally for me, I'vetaken lots of different modality
things in my in my career.
It's been a while since I'vetaken one, because I feel like
they're all kind of variationsof the same thing.
If you are someone that justright out of school and you

(01:02:50):
maybe you're totally aware ofall the evidence based knowledge
that's out there, and you'relike, yeah, okay, I know all
this, totally aware of all theevidence-based knowledge that's
out there, and you're like, yeah, okay, I know all this, I know
all the pain, science, I know aperson's energy, stuff, and I've
had conversations with newgrads that are like, come out
like fully, like yeah, I'velistened to your stuff, I've
listened to so-and-so stuff,like I know all this stuff, but
I just need more tools and I'mlike, yeah, then take those

(01:03:10):
modality courses, learn somedifferent approaches.
That's great.
Just don't believe the BS thatis often not always often being
sold, because there's value inthat.

Anna Maria (01:03:20):
We run.
We run hot stone courses.
Yeah, I love hot stone courses,but we're not going to.
When we run our hot stonemassage courses, we do not build
a narrative about the benefitof the heat, it's a narrative
about experience.
That is enough.

(01:03:41):
We just don't need anythingmore than check the control
indications and make sure thatit is suitable for the person.
Apart from that, it's all aboutthe experience that provides to
the client, because it can besuch a pleasant, wonderful, warm

(01:04:02):
, you know, experience thatactually down-regulates the
nervous system.
And then we can go.
Then, when I talk to them about, for example let's talk about
you, you know challenging thatoverhead movement.

Eric (01:04:17):
There is more chance they will do that because the
pleasant approach establish orreinforce our therapeutic
alliance but also created a safespace in the brain to now do
something that originally couldhave been a little bit more

(01:04:39):
challenging the best massage Iever had in my entire life was a
hot stone massage by somebodythat was not a trained therapist
but just somebody who just wasgood at doing it, and the
treatment I got like that wasthe most delicious thing I've
ever experienced.
It was so good and it reallyopened up my mind to realizing

(01:05:02):
that, like the power of apositive clinical presence with
a, with a touch that feels good,goes a long ways.
Now what's going to be missed,obviously, is pathology or
understanding of mechanism stuff, but if you're just looking for
something great I mean I, I, Istill think that was a couple
years ago I like that was thebest thing I've ever experienced
.
I've never been able to findanother massage that even came

(01:05:24):
close to that I need an example.

Anna Maria (01:05:26):
So let's say, you know somebody, um, uh, she's
suffering with frozen shoulderand it's at acute stage.
It's really obviously reallysuffering and she wants to keep
away.
She's gone through the GP andshe wants to keep away from pain

(01:05:47):
medications.
So she comes to to help withmaintaining the, the range of
motion.
She has to help with a littlebit of pain, but also to help
her with a little bit of painbut also to give herself, like
she says, I want a bit of arespite from suffering.
So we work with that.
I do a little bit of hot stonesbecause on the shoulder it

(01:06:11):
makes her feel really good.
Then we can manage to do a bitof mobilization.
When we do a bit ofmobilobilization, all of a
sudden it says I got a littlebit more movement than I thought
I had.
Not because I increased therange of motion, it's because
she feels so pleasant you usethe beautiful word delicious
then actually the contractilemechanism had a little bit

(01:06:32):
switched off, probably so wecould see what her potential was
.
So she accessed that potential.
Then she goes home and sayslook, in the next few hours show
your brain that you still gotthat potential.
So for that particular hourthat she was in the clinic.
Her experience took her awayfrom suffering.
Look at, away from suffering.

(01:06:55):
Does she know that the massagedoesn't cure frozen shoulder?
Of course she does, but doesthat mean that she should not be
using it?
No, she has been given all theother options.
We looked at all the otheroptions between me and the GP

(01:07:16):
and she actually says I'm okay,I will go through it.
I know that it's pain, I knowthat it can get better.
I just want to be supportedthrough this time.
This is what we're there forand that makes it powerful too
right Like that it's when wetalk about liberating you
dismissive of kind of some ofthe stories and the the
different things that peoplelearn.

Eric (01:07:36):
You know, it doesn't mean that what we're doing doesn't
work.
It doesn't mean that what we'redoing isn't helpful, and that's
, that's the thing.
We need to understand that whenwe are challenging, uh kind of
the status quo of narratives andof beliefs in the profession,
it doesn't mean that what we'redoing has no value, because
that's oftentimes that peoplehear like, oh, you're telling me
I'm useless.

(01:07:56):
I never once used that word.
That's what you think when youhear that what you're doing
isn't working the way you thinkyou're doing.
But you've got 20 years ofclinical experience which is
showing you that people aregetting better.
So don't think that what we'resaying is telling you that
you're useless or that you'renot a good therapist.
It's just that there's newer,more updated knowledge which

(01:08:18):
needs to be adopted, and we canincorporate that into what we
already do, providing thesebeautiful massages, yes, and
even probably more powerful whenwe understand kind of the, the
bigger picture of how our manualinterventions can potentially
impact a person.

Anna Maria (01:08:34):
And this is if we say you know, my final message
would be it's not just changinga narrative because you need to.
It's more than changing anarrative by a narrative.
Although the client might comeout of your room feeling really
good, the narrative you give ofthe treatment, it can provide a

(01:09:00):
nocebic effect on a long term.
So the client may come to youand you say oh, yes, it's
because your pelvis is rotatedright or left, whatever the
sacrum, whatever all thisrotation, and you treat and they
feel better, say yes, because Iput the pelvis back then and
then they will feel great.

(01:09:21):
Yes, because it's aneuromuscular response.
Of course they feel great aftermassage, after touch, but next
time they got the pain again.
What are they going to bethinking?
They're going to be thinking oh, I'm in pain because my pelvis
has gone out again and thereforeI need to go and see Anna Maria
again, because and that isdangerous we know that the

(01:09:43):
person thinking of fragility inthe body and I thinking of the
pelvic going out of pain that isfragility does not have a good
outcome for them.
Well, instead, if you say well,actually you know you're feeling
in pain because there are allthose risk factors.
Some of it is biomechanical ienot previous autoplay but

(01:10:03):
strengths, deficiencies orinflammatory drivers.
Some of them are more systemic.
You know, actually,biomechanically you could have
had those risk factors for 20years.
However, you're feeling themmore now because maybe you're
starting perimenopausal.
So it's actually not thebiomechanical risk factors that

(01:10:24):
the driver is the perimenopause.
So should we go and discusswith the doctor possibility of
HRT?
So this is what our role is isto provide those options.
Yes, then if it's the driver,we can decrease some
biomechanical drivers, butnobody.
They're just impaired.

(01:10:44):
So you know, ultimately thenarrative, it's the first thing
that somebody must changestraight away.

Eric (01:10:58):
Yes, and that's a great final thought because, yes,
understanding narratives areimportant, but they aren't the
only thing, because we can'tjustify everything by just
changing the narrative.
But we'll just leave thatthought there, that the
narrative is important and, uh,you know, hopefully anyone that
listens to this understands thatwe as educators and advocates

(01:11:19):
for our profession, stronglybelieve in the power and the
wonderfulness of what ourprofession can do.
But we are just pushing for usto realize our potential on
opposite sides of the pond to dobetter.

Anna Maria (01:11:32):
I am still in practice after 22 years.
I used to be stronglybiomechanic.
I used to run all the anatomytraining courses, so I used to
be very strongly biomechanicallybased.
If somebody like me embracedwhen evidence-based practice
came into my vocabulary and Igot my views.

(01:11:54):
Why it didn't beforehand?
And I'm not ashamed of it, it'sjust I went into search change.
It actually was liberatingbecause all of a sudden you
start realizing all the quirkythings you see in the clinical
practice, that certain thingsdon't make sense when you are
looking at the evidence.
All of a sudden you think whenyou are looking at the evidence,

(01:12:18):
all of a sudden you think thatmakes sense.
And it's so liberating becauseyou realize it's about you and
the client and there is nocookie cutter.
It's about that.
The relationship is the mostabsolute importance.
So so yes, it's liberating yeah, I would agree.

Eric (01:12:34):
That was my experience too , is I?
I took all the anatomy trainscourses and I was heavily
invested in that as well.
And then, yeah, once you startto um learn some of the current
evidence, it definitely allowsyou to poke holes in those
things.

Anna Maria (01:12:48):
And it starts it starts to make sense now why you
had some successes and why youhad some failures well, let's
say sorry, eric, to stop,because that is something that I
feel very, very, because Ithought about it very deeply.
Why we all embraced the anatomytrains of the fascia movement

(01:13:10):
is because it happened at thetime where we all been in
practice for a while and westarted realizing, you know,
what the biomechanical approachis not the beginning of the end.
So something was started with.
Then we're going to thosefascial anatomy training courses
and this was at the time wherefascial research started having

(01:13:35):
a bit of a resurgence.
And what the fascia researchshowed is that everything is
interconnected, which we wereseeing in practice.
They took it morebiomechanically, but already
they gave us a bit of avocabulary and just made us
think oh, in fact they used totalk about fascia containing
emotions and so on.
So it actually gave us a bit ofan explanation, a vocabulary,

(01:14:00):
for what we were already seeing.
We didn't have any othervocabulary to use because
evidence-based practice didn'tcome into our industry as yet.
But then, once evidence-basedpractice came in, we started
realizing oh, actually, that isa way.
I'm much less wrong with that.
But that's why we all jumped onboard of FASHA, because it

(01:14:25):
allowed.
It was the first time, it wasthe absolute first thing that
moved us away from the verystrict biomechanical perspective
and more of a comprehensiveintegrated movement in the body.
So it made sense to all of usbecause we're starting to think
oh yes, I sure see that.

(01:14:46):
But then when the true, youknow the biopsychosocial model,
which is the closer model to theway we see health and pay we
see health at the moment is, orthe neuromatrix of pain that
makes that is we are again lesswrong.
So I do understand where peoplewent down onto the fascia route

(01:15:07):
.
I totally get it.
Yeah, I was one of them yeah, Iknow, me too.

Eric (01:15:12):
I'm'm the first to admit.
You know that I was, and itmade more sense to me at the
time, and then it's just aconstant evolution.
I think of thinking and of ourclinical, trying to make sense
of our clinical experiences.
And you know, I mean you know,maybe five, 10 years from now,
what we're talking about will bemaybe we're completely wrong

(01:15:32):
now.

Anna Maria (01:15:33):
And that's okay.

Eric (01:15:35):
That's okay.
That's okay.
I think we have to be mindful,um, but I think we will.
We know we are less wrong nowthan we were with with the
anatomy train stuff, and that'sokay that's the best thing we
can do.
That's all, absolutely,absolutely so anyway, henry,
that was lovely as always.
Thank you so much for fortaking the time to be here and I
look forward to having someconversations with you in the

(01:15:56):
future and hopefully we can makeit work.
I can come meet you in personnext year in the UK.

Anna Maria (01:16:03):
Wonderful.
Yeah, we look forward.
We're trying to get you overnow for the last couple of years
.
On the third year we willmanage to get you over here.
Can't wait so it will befantastic.
Thank you very much forinviting me, Eric.

Eric (01:16:15):
I appreciate all you listeners for taking the time to
be here.
If you enjoyed this episode,please give it a five-star
rating and share it on yourfavorite social media platform.
You can follow me on Instagramor Facebook, where you can find
me at ericpervis RMT, and pleasehead over to my website,
ericperviscom to see a fulllisting of all my live courses,
webinars and self-directedcourse options.

(01:16:36):
You can connect with Anna Mariavia her website,
thestschoolcouk.
Until next time, thanks forlistening.